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Biomedical subjects

A B Retik

Publications and source records attributed to A B Retik.

At least 109 records · Page 6Linked to original sources
PubMed1986

Detrusor instability: a delayed complication in association with the artificial sphincter.

Of 45 children with an artificial sphincter 6 had elevated filling pressure of the detrusor and/or uninhibited contractions of the bladder after the implantation surgery, which produced hydronephrosis in 3 and urinary incontinence in 3. All affected individuals had myelodysplasia (17 per cent of this subgroup), 3 had evidence of tethering of the spinal cord and 3 may have had unrecognized detrusor hypertonicity, which was masked by the low outlet resistance before sphincter implantation. Corrective surgery consisted of either decompressive laminectomy with untethering of the spinal cord or augmentation cystoplasty when indicated. Factors affecting the change in the detrusor postoperatively, and recommendations for improved selection and surveillance of individuals undergoing implantation of the artificial device are promulgated.

Child↗
PubMed1985

The use of bowel interposed between proximal and distal ureter in urinary tract reconstruction.

The replacement of lost ureter with bowel interposition is a feasible alternative in the reconstruction of the urinary tract. When adequate ureteral length is not present, interposition of a portion of small bowel between the proximal and distal ureteral segments is an option that minimizes the amount of bowel in the urinary tract. This, in turn, reduces mucus production and electrolyte absorption in the reconstructed urinary tract, and allows for more bowel to remain as part of the functioning gastrointestinal tract. This procedure allows use of the antirefluxing function of the normal ureterovesical junction when present. We have used successfully interposition of the small bowel between the proximal and distal ureteral segments for undiversion in 5 children. Generally, we strive to join urothelium to urothelium without the use of bowel in urinary tract reconstruction but when this is not feasible, bowel interposition has been a useful option.

Child↗
PubMed1984

Predictive value of urodynamic evaluation in newborns with myelodysplasia.

We examined 36 infants with myelodysplasia, using excretory urography, voiding cystourethrography, and urodynamic assessment in the newborn period and periodically thereafter to determine those at risk for decompensation of the urinary tract. Urodynamic evaluation showed 18 with dyssynergia of the detrusor and external sphincter, nine with synergic activity of the sphincter, and nine with no activity of the sphincter. Thirteen (72%) of the group with dyssynergia had or later were found to have hydroureteronephrosis, while this was the case in only two (22%) with synergy and one (11%) with absent activity. The conditions of these 16 patients improved after decompression by cutaneous vesicostomy or intermittent catheterization. Infants with dyssynergia of the detrusor-external sphincter are at high risk for deterioration of the urinary tract; they should be followed up closely, and intermittent catheterization should be started early.

Child, Preschool↗
PubMed1984

Urinary tract infection in boys.

Considerable literature exists regarding the evaluation and treatment of children with urinary tract infection yet little has been reported solely about boys. We reviewed retrospectively 83 boys who were seen after an initial urinary tract infection. Fever was the most common presenting sign (50 per cent) and the most common organisms encountered were of the gram-positive group of bacteria. Escherichia coli accounted for only 21 per cent of the infections. Of the boys 75 per cent (62 patients) had an anatomic abnormality, most commonly vesicoureteral reflux, although more than 25 per cent of our patients had obstructive lesions. Renal scarring was present in half and 58 per cent required early surgical intervention. Urinary tract infection seems to have a higher morbidity in boys and the finding of an atypical organism is to be expected. Based on our findings, we strongly recommend an excretory urogram and a voiding cystourethrogram as the minimal evaluation of boys following an initial urinary tract infection.

Adolescent↗
PubMed1984

The megacystis-megaureter syndrome.

The term megacystis-megaureter describes the radiologic appearance of a large capacity thin-walled bladder and massive primary vesicoureteral reflux. The pathophysiology of these massively dilated ureters and the large capacity bladder is the constant recycling of large volumes of refluxed urine. We treated 29 children between 1 day and 13 years old with this syndrome. Urinary tract infection was present in 74 per cent of the cases. Of these children who presented before 1975, 14 were misdiagnosed primarily as having bladder outlet obstruction, which resulted in inappropriate treatment in 13 and renal deterioration in 5. The remaining 15 children treated after 1975 by means of antireflux surgery alone have remained well with stable renal function and virtual elimination of residual urine. Initial therapy should be aimed at correction of the massive reflux, rather than surgical reduction of bladder capacity or relief of presumed bladder outlet obstruction.

Child↗
PubMed1983

Evaluation and management of children with sacral agenesis.

Sacral agenesis is a rare congenital anomaly of the lower vertebral column which usually produces lower urinary tract dysfunction. Sixteen children with varying degrees of sacral agenesis and urinary symptoms were extensively evaluated. The neurologic lesion varied from no denervation to a complete loss of sacral motor and sensory function. The treatment instituted was individualized and based on specific urodynamic and radiologic findings. Overall, 12 of the 16 children (75%) achieved continence. Clues to the diagnosis including symptoms, physical findings, and the relationship to maternal diabetes are discussed.

Abnormalities, Multiple↗
PubMed1983

Feminizing genitoplasty: a synthesis.

The female child with the adrenogenital syndrome is subject to a variable degree of masculinization. Surgery should be directed to 3 goals: 1) removing the corpora and preserving the glans with its innervation to create a clitoris with normal sensation, 2) creating a normal-appearing introitus by fashioning labia minora from phallic skin and foreskin, and 3) vaginoplasty to provide an adequate opening for the vagina onto the perineum. The entire repair may be completed before the age of 6 months unless the vagina enters the urogenital sinus at a high level in which case vaginoplasty should be delayed until the child is older. The evolution of this operative approach is described and the details of the operative technique are presented.

Adrenal Hyperplasia, Congenital↗
PubMed1982

The management of vesicoureteral reflux in children with myelodysplasia.

We treated systematically 36 children with myelodysplasia and vesicoureteral reflux in an attempt to control infection, eliminate reflux and preserve renal function without diversion. The reflux resolved in 9 of 21 children on intermittent catheterization and remained stable without recurrent infection in an additional 7. Cutaneous vesicostomy in 6 infants temporarily eliminated reflux in 3. Ureteral reimplantation was performed in 11 children (17 ureters) and was successful in all. Transureteroureterostomy was done in 2 children. External sphincterotomy failed to cure reflux in 5 children. Five infants with mild grades of reflux were managed expectantly and 1 had spontaneous resolution of the reflux. Over-all, this systematic approach resulted in cure in 23 patients (64 per cent), stable but persistent reflux without recurrent infection or renal deterioration in 11 (30 per cent) and failure in 2 (6 per cent). No child required urinary diversion. The indications for each treatment modality are discussed.

Child↗
PubMed1981

Cutaneous vesicostomy in infancy.

Cutaneous vesicostomy was performed on 10 infants or young children with hydroureteronephrosis. The etiology of the upper urinary tract dilatation was neurogenic bladder dysfunction secondary to myelodysplasia in 8, and severe vesicoureteral reflux and urinary sepsis in 2. The vesicostomy resulted in marked improvement in the drainage and appearance of the upper urinary tract in each child. When other methods of managing the underlying lower urinary tract dysfunction were deemed more appropriate, the vesicostomy was closed. Cutaneous vesicostomy proved to be an effective, simple and easily reversible means of treating selected infants with lower urinary tract dysfunction.

Child, Preschool↗
PubMed1981

Ureteral ectopia in infants and children.

The diagnosis of ureteral ectopia may be suspected in the girl who wets constantly or in the young boy with epididymitis. More commonly, however, the diagnosis is made during evaluation of the child with urinary tract infection. The ectopic ureter is most often associated with a poorly functioning dysplastic upper pole of a duplex collecting system and in this instance it is best managed by upper pole heminephrectomy and partial ureterectomy. When associated with a single collecting system, ureteral reimplantation can often be performed if salvageable function is demonstrated by a preoperative renal scan. Based on our experience with 48 ectopic ureters in 41 children operated on during the last 11 years, the correlation of the diagnostic findings and surgical approaches to this entity are discussed.

Child↗
PubMed1981

Congenital mesoblastic nephroma: relationship to other renal tumors of infancy.

Although nephroblastomas (Wilms tumor) do occur in the newborn most of the solid renal tumors in this age group constitute a distinctly different pathologic entity, congenital mesoblastic nephroma. While a more cellular histologic variant of congenital mesoblastic nephroma has been recognized recently, which occasionally may follow a malignant course, the tumor with conventional histology has never been reported to metastasize and follows a benign course when treated by adequate local excision alone. We report our 50-year experience with 11 cases of this tumor (9 cases with conventional histology and 2 with cellular variant histology). Typically, the tumor presented in the newborn as a large asymptomatic mass. Local invasion was never seen and the tumors were resected without difficulty. Grossly, the tumors usually resembled a uterine "fibroid" and, unlike nephroblastomas, rarely exhibited hemorrhage or necrosis. Microscopically, the conventional histologic congenital mesoblastic nephroma was composed of sheets of spindle-shaped cells. The cellular variant of congenital mesoblastic nephroma exhibited increased cellularity and a higher mitotic index. The relationship of congenital mesoblastic nephromas to other neonatal renal tumors is discussed and a unifying schema of neoplasia in infantile renal tumors is proposed.

Diagnosis, Differential↗
PubMed1980

Dilemma of small pyelonephritic kidney associated with vesicoureteral reflux.

Nineteen children with severe unilateral pyelonephritic scarring secondary to reflux and infection were followed up for at least five years after ureteral reimplantation. The small kidneys in these children grew at a rate which paralleled expected normal, and this growth was independent of the degree of hypertrophy in the contralateral kidney or the size difference between each pair of renal units. The authors differentiate between obligate and compensatory renal growth and conclude that children with a small pyelonephritic kidney should undergo reimplantation rather than nephrectomy because of the recuperative powers of the growing kidney and its ability to become a potentially life-sustaining organ in the future.

Adaptation, Physiological↗
PubMed1980

Urinary undiversion in myelodysplasia: criteria for selection and predictive value of urodynamic evaluation.

Urinary undiversion was done in 15 children with myelodysplasia and ileal conduits. The process of evaluation and the criteria for selection are described. Neurologic and psychologic factors have an important role. Electromyography of the external urethral sphincter is helpful in predicting which children would be continent after undiversion and in managing the neurogenic bladder postoperatively. Over-all, a successful outcome has been achieved in two-thirds of the children chosen for undiversion.

Child↗
PubMed1980

Ureteroceles in infants and children.

Ureteroceles in childhood have a broad spectrum of presentation, anatomy and pathophysiology and, thus, treatment must be individualized. We evaluated 64 children with 72 ureteroceles who underwent operation. Their presentation, radiographic findings, operative management and postoperative results are discussed. Simple or orthotopic ureteroceles often require no operation unless they are large enough to obstruct the urinary tract. Then excision of the ureterocele and ureteral reimplantation are recommended. There are a number of options available for the management of ectopic ureteroceles. The procedure of choice is upper pole heminephrectomy and partial ureterectomy in the majority of ureteroceles associated with a poorly functioning upper renal segment. Specific indications for each of the other surgical techniques considered acceptable at present are discussed.

Adolescent↗